Organization
ALEXANDRA Y PEACOCK CATHCART DMD LLC
Active
Other names
Coastal Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDRA YAMVA PEACOCK CATHCART D.M.D. (OWNER)
(413) 446-6346
Entity
Organization
Contact information
Practice address
110 AUBURN STREET, PORTLAND, ME 04103
(207) 797-7433
(207) 797-7720
Mailing address
110 AUBURN STREET, PORTLAND, ME 04103
(207) 797-7433
(207) 797-7720
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3047
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124010000
—
ME
Enumeration date
03/21/2007
Last updated
06/27/2024
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